Healthcare Provider Details

I. General information

NPI: 1255726832
Provider Name (Legal Business Name): NICHOLAS ROBERT PAUL LUDVIK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5295 PRESERVE PKWY STE 210
HOOVER AL
35244-4702
US

IV. Provider business mailing address

3500 BLUE LAKE DR STE 495
VESTAVIA AL
35243-1975
US

V. Phone/Fax

Practice location:
  • Phone: 205-682-6077
  • Fax: 205-682-7646
Mailing address:
  • Phone: 205-682-6077
  • Fax: 205-682-9131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35746
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: